Appendectomy

Overview of Treatment

Appendectomy is a surgical procedure used to treat acute appendicitis, primarily aiming to remove the inflamed or ulcerated appendix to prevent rupture and subsequent peritonitis. This surgery is typically performed immediately after diagnosis to prevent the spread of infection and life-threatening complications.

The procedure can be performed via traditional open surgery or laparoscopic surgery, depending on the patient’s condition and the surgeon’s judgment. Indications include typical symptoms such as right lower abdominal pain, fever, or imaging confirming appendiceal swelling. In emergency cases, surgery may be performed within 24 hours to reduce the risk of complications.

Types and Mechanisms of Treatment

There are mainly two types:

• Traditional open appendectomy: a 5-8 cm incision is made in the right lower abdomen to directly remove the appendix and suture.
• Laparoscopic appendectomy: using 3-4 small incisions to insert a camera and instruments for minimally invasive removal.

Both methods involve ligating the blood vessels and removing the appendix. The laparoscopic approach results in smaller incisions but requires suitable anatomical conditions.

The mechanism involves removing the diseased tissue to prevent rupture of the appendix, which could lead to peritonitis or sepsis. Laparoscopic techniques can reduce tissue damage but must be performed by experienced surgeons.

Indications

Mainly applicable to:

• Confirmed cases of acute appendicitis, such as elevated white blood cell count or an appendix diameter greater than 6mm.
• Suspected ruptured appendix causing peritonitis, presenting with diffuse abdominal tenderness and rebound pain.
• Recurrent appendicitis or formation of appendiceal fistulas.

Special cases such as late pregnancy require adjustment of the surgical approach.

Contraindications are rare but include patients with severe coagulopathy or systemic sepsis and shock, who may need stabilization before surgery. Careful assessment of anesthesia risks in patients with cardiopulmonary insufficiency is necessary.

Usage and Dosage

The surgery requires general anesthesia, and hospitalization duration varies by type:

• Laparoscopic surgery: 2-3 days, with incisions about 1-2 cm.
• Open surgery: 5-7 days, with longer wound recovery time.

Postoperative management includes pain control, antibiotics, and adherence to dietary instructions.

There are no specific drug dosages involved, but anesthesia doses are adjusted based on weight and physiological indices. Elderly patients may require preoperative cardiopulmonary assessment and adjustment of anesthetic agents.

Benefits and Advantages

Main benefits include:

• Complete removal of the diseased tissue, preventing rupture.
• Laparoscopic approach reduces tissue trauma and accelerates recovery.
• Lower risk of severe complications such as peritonitis.

Long-term follow-up shows a recurrence rate of appendicitis below 1%.

The advantages are immediate resolution of emergency symptoms with a success rate exceeding 95%. Laparoscopic techniques further reduce postoperative pain and scarring, suitable for young patients and obese cases.

Risks and Side Effects

Possible risks include:

• Wound infection or abscess formation (incidence about 5-10%).
• Bowel leakage or obstruction (incidence about 1-3%).
• Anesthesia-related complications such as respiratory depression.

Severe complications may require secondary surgery or lead to long-term issues.

Laparoscopic surgery may increase residual carbon dioxide gas, causing shoulder pain, but this is usually temporary. Elderly patients may have increased postoperative risks related to cardiopulmonary insufficiency.

Precautions and Contraindications

Preoperative preparations include:

• Fasting for at least 8 hours and blood tests.
• Informing the medical team of allergies and current anticoagulant medications (e.g., aspirin).

Absolute contraindications include patient refusal and uncontrolled systemic sepsis.

Relative contraindications include severe coagulopathy or heart failure, which require infection control with antibiotics before evaluation. Postoperative monitoring of wound healing and bowel motility is essential.

Interactions with Other Treatments

The surgery itself does not directly interact with medications, but attention should be paid to:

• Discontinuing anticoagulants (such as warfarin) 7 days before surgery.
• Timing of antibiotic administration, usually within 30 minutes before skin incision.

When combined with chemotherapy or immunosuppressive therapy, medication adjustments may be necessary.

If the patient is on antiplatelet therapy (e.g., Plavix), collaboration with a hematologist is required to assess bleeding risk. Diabetic patients should have their blood glucose levels managed appropriately before surgery.

Effectiveness and Evidence

Clinical studies show:

• Laparoscopic surgery results in shorter hospital stays (average 2.5 days vs 5 days).
• Five-year follow-up indicates a chronic abdominal pain incidence below 2%.
• Infection control rates for emergency and prophylactic surgeries are 98% and 100%, respectively.

Randomized controlled trials confirm that laparoscopic techniques have lower complication rates and higher patient satisfaction compared to traditional open surgery.

The American Surgical Association recommends that all suspected appendicitis patients undergo surgical evaluation within 24 hours, as delays increase perforation risk by 2% per hour.

Alternative Options

A very small number of cases may consider non-surgical treatments:

• Selective observation: limited to high-risk patients (e.g., end-stage renal failure) for short-term use.
• Antibiotic therapy: suitable only for early mild inflammation, with close monitoring.

However, success rates are approximately 70%, with a recurrence rate of 30%.

Alternative approaches require strict evaluation. Immediate surgery is necessary if inflammation exceeds 48 hours or perforation has occurred. Non-surgical treatments still require regular imaging follow-up.

 

Frequently Asked Questions

What preparations are needed before surgery? What should be noted on the day of surgery?

Before undergoing appendectomy, patients need blood tests, abdominal ultrasound or CT scans to confirm the diagnosis. Fasting for at least 8 hours and discontinuing anticoagulants as advised are necessary. On the day of surgery, remove metal objects, change into surgical gowns, and the medical team will explain the procedure and risks in detail before anesthesia.

What are the pain management options after surgery? How to determine if pain is abnormal?

Postoperative pain is usually controlled with analgesics (such as NSAIDs or opioids), along with ice packs or gentle mobilization. Sudden worsening of pain, fever, or vomiting may indicate complications and require immediate medical attention. Patients should take medications as prescribed and avoid delaying activity or rehabilitation due to fear of pain.

How should diet be resumed after surgery? Are there foods to avoid?

Initially, clear liquids such as rice porridge or apple juice are recommended, gradually progressing to low-fiber whole grains and soft foods. High-fat, high-fiber foods (fried foods, whole wheat) and dairy products should be avoided to prevent gastrointestinal discomfort. Recovery varies among individuals; a gradual return to normal diet with monitoring is advised.

When should open surgery be considered instead of laparoscopic? How to assess risks?

If the appendix has perforated, severe inflammation, or adhesions, laparoscopic surgery may be difficult, and open surgery is preferred. Risk assessment is based on age, obesity, and severity of infection. Surgeons will choose the safest approach based on real-time conditions and explain the differences in recovery time between the two methods.

How long does full recovery take? When can patients resume exercise or work?

Patients undergoing minimally invasive surgery typically can engage in light activities within 1-2 weeks, while open surgery may require 4-6 weeks for full recovery. Office work can usually resume after about 3 weeks, but lifting heavy objects or strenuous exercise should be avoided for at least 6 weeks. Surgeons will provide tailored advice based on wound healing and recovery progress, and patients should avoid exerting too early to prevent wound dehiscence.